May is National Osteoporosis Prevention Month.
I've filed this post under my "Big Pharmachine" category because the things that I say here ~ all of the criticisms and judgements, both stated and implied will apply to all of the shenanigans of the pharmaceutical giants. With a few exceptions ~ osteoporosis drugs to vaccinations to flu shots to pain medications, arthritis drugs, cholesterol drugs, high blood pressure drugs, reflux drugs, antibacterial products... ....it's all a big game for the big pharmachine. Even if the theory behind each drug or procedure is sound, the big pharmachine has managed to shrink each one down to the lowest common denominator ~ greed. Greed and quality healthcare don't belong together and they don't work together. I don't think any of these drugs are working on a widespread basis...really. All drugs "work" at the expense of one or more natural biological process(es) ~ they are designed to intentionally short-circuit the built-in wisdom of our bodies. And if you or someone you love is dependent on anything the big pharmachine produces.......my intent here is not to further your pain but to give you a jumping off place, from which you might find a light at the end of the tunnel. It's all about your education.
My family, friends, patients, colleagues, will recognize this as perhaps my most familiar soapbox. I spend a lot of time reading, thinking, and talking about the big pharmachine. I accept that much of what I write here will sound like the rantings of a conspiracy theorist to someone who is not familiar with my passion on this subject. It's what happens when a small player like me, with only my gut feeling, my research, and my passion comes up against a machine this big and rich and powerful. All I ask is that you read my post in its entirety with an open mind; check my sources; pursue the link trail; and follow the money...above all, follow the money. As you read, ask yourself these questions: "Who stands to loose the most if any or all of this is true?" And: "Will I (you), as the health consumer gain anything if I come to believe that any or all of this is true?"
My main source for information today is the article "Bones of Contention," by James Keough, in the April 2007 issue of Alternative Medicine . He brings together many different and diverse experts, articles, and studies in this one article. This is a lengthy, but valuable article ~ well worth the time.
Keogh's discussion is centered on the topic of how the big pharmachine managed to make osteoporosis front page news in the early 1980's, following the discovery that synthetic estrogens (primarily Ayerst's Premarin) tended to cause endometrial cancer in women who were instructed to take it for symptoms and "problems" of menopause during the 1960's and 70's. As you might expect, estrogen sales dropped and stayed down, leading Ayerst to hire a "top public relations firm in 1982 to market osteoporosis to the public using TV, radio, and magazine ads. An old woman with a dowager's hump was the comapaign's poster child. Prior to this effort...77 percent of women had never heard of osteoporosis."
Keogh goes on to describe how the marketing geniuses and the newly formed National Osteporosis Foundation proceeded to design machines to detect osteoporosis and then set about establishing new definitions for this dread disease and its brand new precursor, osteopenia. The true definition of osteoporosis is complex, and includes terminology which focuses on brittle weak bones that fracture easily. The new definition, chosen to benefit the new publicity campaign is the vastly diluted phrase "low bone density." As a result of this change, the phrase "low bone density" was promoted from being just one of a long list of risk factors to the full definition of osteoporosis. "Low bone density" became the disease.
The first of many problems with this new definition of the disease is that there is no correlation between low bone density alone and bone fractures. Scientists in study after study have concluded that fracture risk cannot be determined by bone density.
Next, the machines which are held up as the "gold standard" for bone density testing (known as DEXA ~ for dual energy x-ray absorbtiometry), measure the bone density of subjects against the "average peak bone mass of a healthy young Caucasian woman." How does this make sense for a non-Caucasion woman, or a non-young woman, or someone with a chronic health condition, or a man? As it turns out, peak bone mass varies widely depending on one's ethnicity, one's age (it is normal to loose bone density as we age ~ this is not a pathological process), where one lives, and the season of the year. Add to that the fact that DEXA machine manufacturers don't follow any one standard for calibrating their machines...meaning that the average peak bone mass varies depending on the brand of the machine ~ makes this a completely useless measurement. And doctors are using results from these machines to prescribe drugs which disrupt the natural process of bone remodeling and have very serious side effects.
Bone remodeling is a natural, dynamic process that continues all through our lives. Our skeleton is a living organ system that undergoes a constant breakdown/build up cycle known as remodeling. Even once our bones have finished all of their growth activities in early adulthood, this remodeling is the maintenance that our bodies perform to keep bones healthy. One kind of bone cell is responsible for removing old or injured bone, while another makes replacement bone. New replacement bone is always healthier than old bone. Osteoporosis drugs suppress one side of this remodeling equation, resulting in an apparent increase in bone density. Indeed drugs like Fosamax and Actonel halt bone breakdown by as much as 90%.......but eventually bone replacement is reduced by the same amount because it is a process of give & take/death & new life, and our bodies will always balance themselves out to a condition of homeostasis. These drugs increase bone density at the expense of the stronger and less brittle replacement bone ~ leaving bone that looks sturdy on a DEXA scan, but is actually more fragile because it has missed out on its normal maintenance process. And this is just one in a long list of side effects.
I can't move on with this post without saying something about the economics of osteoporosis. According to Keogh, in 2005, American physicians wrote 39 million prescriptions for osteoporosis drugs, including 22 million specifically for Fosamax. This translates to an incredible $3.2 billion for the big pharmachine Merck from just this one drug in this one year. He also reports that the global osteoporosis market has been estimated at $6 billion, with a growth rate of 25% per year. Huge money that brings with it equally huge motivation for the big pharmachine to keep things just as they are. One PhD quoted in Keogh's article puts it this way: "It's difficult to have clear thinking when one's financial interest is so great." And an OB/Gyn is quoted in the same paragraph as saying: "I rarely criticize the drug companies, but in this case I have to say the publicity about osteoporosis is mostly about profits, not about women's health."
For me, the bottom line from this article is this quote from Mark Helfand, MD, MPH, MS, of Oregon Health and Science University: "Most of what you can do to prevent osteoporosis...has nothing to do with getting a test or taking a drug." This statement is not flashy, and it certainly isn't going to make a lot of money for anyone, but it vibrates powerfully with truth.
So now what?
The more wholistic way to acheive long term healthier bone density involves eliminating foods and activities that cause bone loss, and increasing foods and activities that support bone remodeling.
First, healthy activites to encourage strong bones: bone remodeling works, in large part, on an "as needed" basis ~ meaning that where your muscles put demands on your bones (as in when you exercise), more replacement bone is produced and the bone becomes stronger...more dense there. While any form of exercise is a good thing, only weight-bearing exercise puts enough of the right kind of stress on bones to encourage increased density in them. So, while that water aerobics class or walking program will do great things for your heart and lungs, you really need to pick up some light weights and find a yoga, calisthenics, or exercise ball class that encourages you balance your body weight on your arms at times in order to benefit your bones the most.
Please use caution when you start a new exercise program, and recruit family and friends to join you. A workout partner is great for making that time speed by, and for holding you accountable for staying dedicated to your new goals.
As for nutritional changes ~ the number one recommendation is also the most far-reaching one. Metabolic acidosis ~ eating a diet that is too high in sugar, animal protein, and refined carbs (the typical American diet) causes our bodies to become too acidic, and to rob minerals from our bones as it tries to buffer the acidity produced by our diet. To turn down the acidity in your body, eat more raw, fresh, organic, high-quality fruits and vegetables. I know, I know! It's the same old song & dance, but I wouldn't keep doing it if it wasn't the right thing to do.
When choosing supplements to combat osteoporosis, you might be surprised to learn that the most important supplement is vitamin D rather than calcium, (this should make the big dairy industry happy!). Vitamin D levels are relatively easy to test (a simple blood test), and not hard to supplement. You can start by spending 15 - 20 minutes each day in the sun, with as much skin exposure as you can manage (NO SUNSCREEN), and/or take vitamin D3, in the form of a good quality cod liver oil (fortunately it is possible to get this in capsules!!). I recommend that you stay away from synthetic vitamin D (this goes for all synthetic supplements, by the way).
You will need to supplement calcium, but be sure to buy a good quality product that is available for use by your body, (known as bioavailability). Be aware that more than perhaps any other supplement, calcium suffers from from a lot of public disinformation and inaccurate marketing. I will write more about this in a subsequent post, but for now just know that you get what you pay for, and my recommendation is to pay as much as you possibly can for a good quality calcium supplement from a reputable company.
The list of things to avoid or eliminate is as follows: smoking, excess alcohol comsumption, caffeine, strict calorie restriction, drugs, digestive disorders, stress, and endocrine disorders. James Keogh handles each of these to a fair degree in his article. For your individual needs and to learn more about my specific recommendations for you, please contact me here .
